Basic Information
| Provider Information | |||||||||
| NPI: | 1548656432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUGGIERO | ||||||||
| FirstName: | GAETANO | ||||||||
| MiddleName: | TREY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RUGGIERO | ||||||||
| OtherFirstName: | TREY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8585 PICARDY AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253877918 | ||||||||
| FaxNumber: | 2253723717 | ||||||||
| Practice Location | |||||||||
| Address1: | 8585 PICARDY AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257634764 | ||||||||
| FaxNumber: | 2257634549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 309555 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.